Systems - Resp - first half

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jonas112
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244955
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Systems - Resp - first half
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2014-11-12 14:07:44
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Systems Resp first half
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Systems - Resp - first half
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  1. What are 4 key things to remember with kids with pneumonia?
    • 1) recurrent may mean immunocompromised or mucociliary escalator problems
    • 2) asplenia leads to pneumococcal disease
    • 3) infants with GERD or TE defects may get aspiration pneumonia
    • 4) right sided focal lesion in toddler: think foreign body
  2. What do you look at on a CXR where you think they have pneumonia?
    • 1) interstitial infiltrates
    • 2) Consolidation
    • 3) Pneumatoceles (cavity-like area)
    • 4) Pleural effusion
  3. What is the most common type of pneumonia in school aged kids, specific clinical signs.
    • 1) Mycoplasma pneumoniae
    • 2) most finding are unilateral and in the lower lobe
    • 3) cold agglutinins after one week (IgM clumps in the blood at 4 degrees C)
    • 4) treat with *mycin drugs for 2 weeks
  4. What does co-oximetry measure and calculate?
    • Measures: OxyHb, COHb, MetHb, Total Hb
    • calculates: HHB (deoxy Hb)
  5. What are some complications of obtaining arterial blood gasses?
    • 1) pain
    • 2) bruising/hematoma
    • 3) nerve damage (radial nerve is close)
    • 4) Thrombosis
    • 5) sepsis
  6. What causes hypoxemia?
    • 1) low inhaled O2 partial pressure
    • 2) reduced alveolar ventilation
    • 3) impaired diffusion
    • 4) V/Q mismatch
    • 5) Shunt
  7. What are the CO2 levels or HCO3- levels you think you would see in metabolic and respiratory alkalosis and acidosis?
    • metabolic acidosis: decreased HCO3-
    • metabolic alkalosis: increased HCO3-
    • respiratory acidosis: increased PaCO2
    • respiratory alkalosis: decreased PaCO2
  8. define asthma
    • disorder of the airways characterized by:
    • -paroxysmal (sudden recurrence) persistent symptoms
    • -variable obstruction
    • -hyperresponsiveness due to a number of stimulii
    • -inflammation
  9. How would you asses asthma severity?
    • 1) Sx
    • 2) FEV1
    • 3) Morbidity
    • 4) beta 2 requirements
  10. Describe ideal asthma control
    • -Symptoms <= 3 times a week, none at night
    • -rescue beta use (same as above)
    • -normal lifestyle
    • -no morbidities (missing work/school, etc)
    • -FEV1 >90% of personal best
  11. What are the 4 main medications used in asthma control and what do they do?
    • 1) bronchodilators
    •   -beta 2 agonists (short acting)
    •   -long acting beta 2 agonists (LABA)
    • 2) anti inflammatories
    •   -LTRA (leukotriene receptor antagonist)
    •   -corticosteroids
  12. What are three things that should come to mind if asthma therapy isn't helping a patient?
    • 1) non-compliance
    • 2) Not (only) asthma
    • 3) Severe asthma
  13. What are the 6 facets of asthma exacerbation managment?
    • 1) asses
    • 2) Cause
    • 3) Asthma Rx
    • 4) Supportive Rx
    • 5) monitor for complications
    • 6) follow up (give them a written action plan)
  14. Define FVC, VC, FEV1
    • FVC - forced exhalation from maximal inspiration
    • VC - slow exhalation from maximal inspiration
    • FEV1 - forced exhalation from max inspiration in the first second
  15. PFT parameters are standardized to what? Which of these lack good standardization data?
    • age
    • gender
    • height
    • (race is important too)
    • lack good standardization values for extremes of age.
  16. What are 2 big factors that affect FRC?
    • anaesthesia reduces FRC
    • obesity reduces FRC
  17. 2 big factors that affect VC and TLC
    increased compliance (emphysema) increases VC and TLC

    increased elastance (fibrosis) decreases VC and TLC
  18. What does a high or low FEV1/FVC mean? What limit is characteristic of asthma or COPD?
    • high: restriction 
    • low: obstruction

    Ratio of < 0.7 is diagnostic of these obstructive diseases
  19. What is Cystic Fibrosis?
    • -autosomal recessive mutation of Cl- channel proteins
    • -multisystem: lung, panc, liver, GI/nutrition, bones, sleep, reproductive)
  20. Definition of pulm HTN and the five classification categories
    • >25 mm Hg (normal is 15)
    • 1) arterial pulm HTN
    • 2) increased venous pressure due to left heart disease
    • 3) hypoxic vasoconstrict due chronic lung disease
    • 4) chronic thromboembolitic disease
    • 5) unknown etiology
  21. What are some clues that someone has CF (5)
    • -clubbing
    • -congenital absence of the vas deferens
    • -malabsorption and steatorrhea
    • -meconium ileus
    • -electrolye ELEVATION in the SWEAT (opposite of how it works in the lungs)
    • -Chronic cough
  22. 4 signs of pulmonary HTN
    • -loud, palpable P2
    • -HV heave
    • -Right sided S4
    • -tricuspid regurg
  23. How would you conventionally treat CF? (4)
    • 1) clearance of lower airways (physio, mechanical, forced expiration)
    • 2) Treat resp infections
    • 3) replace pancreatic enzymes
    • 4) reverse secondary nutritional and vitamin deficiencies
  24. What is the most detrimental factor to growth in kids?
    asthma
  25. What are 5 causes of ICS failure in chronic cough in kids?
    • 1) Low compliance
    • 2) Dosage is too low: start high and go low
    • 3) Method of administration is inappropriate
    • 4) Comorbidities: persistent allergen exposure, aspiration/GERD, sinusitis
    • 5) purulent airways (CF, bronchiectasis, etc)
  26. What is a critical factor you can use to differentiate asthma from vocal cord dysfunction?
    Vocal cord dysfunction goes away at night.
  27. How many apneas/hypopneas are needed to be pathologica (4 grades)
    • normal: < 5/hour
    • mild OSA: 5-15/hour
    • moderate OSA: 15-30/hour
    • severe OSA: >30/hour
  28. What are some associations between OSA and the CV system?
    • 1) arterial hypertension: stroke, LV dysfunction
    • 2) pulmonary HT
    • 3) arrhythmias
  29. What are the 4 types of treatment for OSA?
    • 1) Conservative (lose weight, positional therapy, alcohol avoidance)
    • 2) CPAP
    • 3) Mandibular advancement devices
    • 4) Surgery
  30. What are the symptoms of restless leg syndrome?
    • the URGE symptoms:
    • -intense Urge to move legs
    • -symptoms worsen at Rest
    • -relieved by Getting up
    • -worse in the Evening
  31. What is the difference between a nodule and a mass?
    • nodule < 3cm
    • mass > 3cm
  32. describe the 4 stages of lung cancer
    • Stage I: 10-30% resection rate, 75% survival
    • Stage II-III: confined to chest, a role for multimodal therapy
    • Stage IV: palliative
  33. Where are most lung cancers?
    apical. mets are lower because of the increased blood flow
  34. What would be a characteristic spirometry reading for someone with COPD?
    • FEV1/FVC < 0.7 (post bronchodilator)
    • decreased diffusion capacity
    • obstruction
    • FEV1 less than predicted
  35. What are the 3 situations you would give oxygen for COPD?
    • 1) PaO2 <= 55 mmHg AND SaO2 is <=87%:  always give oxygen!
    • 2) 55<= PaO2 <= 59 mmHg AND SaO2 is < 90%:  if they have cor pulmonale and polycythemia, history of edema
    • 3) PaO2 >59 AND SaO2 > 90%:  desaturation during exercise, 20% improvement with O2, sleep dyspnea that CPAP doesn't help
  36. etiologies of obstructive pulm disease
    • ABCT
    • asthma
    • bronchiectasis
    • cystic fibrosis/COPD
    • Tracheal or broncheal obstruction
  37. Treatment progression in asthma (5)
    • 1) education, environment control, written action plan+fast acting bronchodilator
    • 2) add inhaled corticosteroid or LTRA
    • 3) add LABA
    • 4) add LTRA of not already on it
    • 5) systemic corticosteroids (prednisone)
  38. Treatment for COPD (5)
    • COPD'R
    • Corticosteroids
    • Oxygen
    • Prevention (smoking cessation, vaccines)
    • Dilators (B2 agonist - salbutamol; anticholin - atrovent)
    • Rehab
  39. how do you differentiate emphysema from chronic bronchitis?
    emphysema: pink puffer (pink skin and pursed lip breathing)

    chronic bronchitis: blue bloater (cyanosis, fat, chronic purulent cough)
  40. List causes of ILD that affect the upper lung lobes (4) and lower lung lobes (4)
    Upper (FACTS, often end in 'sis): Farmer's lung (hypersens), Ankylosing spondylitis, Coal miners pneumoconiosis , TB, Sarcoidosis

    Lower (CARS) : Cryptogenic Organizing Pneumonia, asbestosis, rheum diseases, scleroderma
  41. What is a drug commonly implicated in causing ILD
    amiodarone
  42. Organize the following ILD's:
    Coal Worker's pneumo
    Silicosis
    Crypto-organizing pneumonia
    Asbestosis
    Sarcoidosis
    Farmer's Lung
    Usual Interstitial Pneumonia (aka IPF)
    Desquam interstitial pneumonia
    Lymphoid Interstitial pneumonia
    Non-specific interstitial pneumonia
    Pigeon Breeder's lung
    berylliosis

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